Global Surgery in Senegal

Glasgow is blessed with a rich history of science discovery, innovation and progress, led by some of the greatest scientific pioneers on record – both old and new. It is less a question of finding work to feature, and more a case of seeing how much we can proudly present within the constraints of the time available. One exciting thing to look forward to is an inaugural year-long series special on Global Surgery. Five billion people, more than two-thirds of the world’s population, do not have access to safe and affordable life-saving surgery; whether that’s for a difficult childbirth, a road traffic accident or for cancer. This theme was selected not only because of its nature as a global humanitarian imperative, but also because it spans every area of science and will require organised interdisciplinary and international effort to tackle… and most importantly – by us. Without further ado, thank you to our first global surgeon – Dr Catherine Juillard from San Francisco, California.

Catherine Juillard served as a Peace Corps Rural Health Volunteer for three years in Senegal prior to attending medical school and it was from there that her interest in global surgery stemmed. As a general surgeon with clinical interests in trauma and critical care, Dr Juillard obtained a Bachelor of Arts from Stanford and her M.D. degree from University of California, Los Angeles (UCLA), before receiving her M.P.H. from Johns Hopkins School of Public Health and continuing her post-doctoral fellowship with the John Hopkins International Injury Research Unit. After completing her General Surgery residency, she completed a fellowship in Trauma and Critical Care at University of California, San Francisco (UCSF). Dr Juillard has a strong interest in global surgery research and was recently named Co-Director of the UCSF Center for Global Surgical Studies. At the department, she improves access to surgical and trauma care in low- and middle-income countries through health systems strengthening.

Global Surgery in a nutshell?

That’s a tough one. We have an organised system of healthcare here that we take for granted and in other countries, that just doesn’t exist. Injury is one of the biggest killers globally and it affects young, healthy people too. We know that it doesn’t just happen by accident, and the only way to prevent it from happening is by studying it.

How did you get into global surgery?

The thing that really rooted by interest was being a Peace Corps volunteer in my early twenties. I was interested in medicine, but not convinced it was the path for me. I went to live in Eastern Senegal in a very small village for nearly three years. There was no running water, no electricity and the only the language was Pulaar, so I learned that while I was out there. The key event that happened was that I was in a car crash in which two people died. After that I realised what it meant for a country to not have an emergency response system. Before that I didn’t really see it as a public health problem so that was when health became very real for me. You are just left on the side of the road, left to figure it out and you are only reliant on the good Samaritans that happen to be walking by. So I made the decision to go to medical school because I wanted to be able to do something to help people in that position. I loved the immediacy of surgery and also the satisfaction of reversing a catastrophic event, even more so when in healthy, young people.

Biggest achievements in global surgery so far?

I think the biggest achievement so far is that it is now actually a field. Public health was so initially rooted in infectious diseases and vertical disease interventions. It has been a very slow shift to realise that there are many other types of disease states that can be analysed and improved using the exact same evidence-based techniques, and I think injury is a perfect example of this.

Best piece of advice you’ve ever received?

Always do what you love. I made a decision to do surgery and although many people advised me against it. I decided I didn’t want to be in academics unless I could do that so I was going to try it and if it didn’t work out I would try something else. You make little compromises along the way, but always try to make your long-term goal something that you really care about. Another thing that really stuck with me was something the former chair of our department said. When you’re having a bad day, go talk to a patient. It’s very easy to get caught up in getting things done, but doing that reconnects you with the people who brought us into this in the first place and reminds us why we do it.

Mentors?

I met Charlie Mock at the World Health Organisation (WHO) while I was applying for residency, trying to figure out how to merge surgery with my interest in public health. Looking at surgical disease from a public health perspective was really novel at the time, and he really was one of the pioneers in the field. I quickly latched onto him as a mentor.

Dr Juillard is also Director at the San Francisco Wraparound project at Zuckerberg San Francisco General Hospital, recently featured in a short documentary by BBC Global Hacks. The core mission of the Wraparound Project is the prevention of violence through culturally sensitive community interventions and support of its victims through proactive outreach, empathy and emotional sustenance. Mike Texada is the Supervising case manager and answered a few questions about some of the project’s activities today.

Wraparound ‘closes the loop’ in violent crime?

Yes, we link the families up with services to provide them with the resource they need to get to the root of why they are here in hospital. We connect patients to resources in the community, including mental health services, court advocacy, workforce development and housing support. We also have trauma pagers like trauma surgeons, so we’re involved with the patients right from the start.

Your involvement with the project?

I’ve been with the project for the entire 11 years since it’s start. Over that time, we have seen the rate of crime in San Francisco drop from 8 to 4% since the implementation of the program. We follow clients from 6-12 months depending on the case and severity. We call it the ‘teachable moment’, empowering folks who probably didn’t believe in themselves at one point but really needed that extra support from services available to them in their time of need.